Diabetes is a complex and heterogeneous disease, making the prediction of the risks of diabetic complications challenging. Novel adult-onset diabetes subgroups have been studied using cluster analysis, but its application in East Asians remains unclear. We conducted a retrospective cohort study to elucidate the clinical utility of cluster-based subgroup analysis in the Japanese population. Cluster analysis based on anti-glutamate decarboxylase antibody (GAD antibody) levels, age at diagnosis, body mass index (BMI), hemoglobin A1c (A1c), and homeostatic model assessment 2 estimates of β-cell function and insulin resistance was performed in 1520 diabetic patients. The risk of developing diabetic complications was analyzed using Kaplan–Meier analysis and the Cox proportional hazards model. By cluster analysis, we identified five distinct subgroups of adult-onset diabetes in the Japanese population. The risk of diabetic complications varied greatly among the clusters. Patients with severe autoimmune diabetes or severe insulin deficiency diabetes were at an increased risk of diabetic retinopathy, and those with severe insulin resistant diabetes (SIRD) had the highest risk of developing diabetic kidney disease (DKD). After adjusting for uncorrectable and correctable risk factors, SIRD was found to be an independent risk factor for DKD. In conclusion, we identified five subgroups of adult-onset diabetes and the risk factors for diabetic complications in the Japanese population. This new classification system can be effective in predicting the risk of diabetic complications and for providing optimal treatment.

BackgroundIt is unknown whether canagliflozin, a selective sodium glucose co-transporter 2 inhibitor, reduces epicardial adipose tissue (EAT) thickness, which is associated with insulin resistance and is a risk factor for coronary artery disease.Methods and resultsWe administered 100 mg of canagliflozin for 6 months to 13 patients with type 2 diabetes mellitus. We evaluated glycemic control, visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area, and skeletal muscle mass by using impedance methods, and EAT thickness by using echocardiography. Canagliflozin treatment for 6 months decreased hemoglobin A1c level from 7.1 ± 0.5% to 6.7 ± 0.6% (P < 0.05) and decreased EAT thickness from 9.3 ± 2.5 to 7.3 ± 2.0 mm (P < 0.001), along with a trend of decreasing VAT and SAT area. No association was found between any of these changes.ConclusionCanagliflozin reduced EAT thickness in patients with type 2 diabetes mellitus independent of its effect on lowering blood glucose, suggesting that canagliflozin may have an effect in preventing cardiovascular events in these patients (UMIN000021327).Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-017-0275-4) contains supplementary material, which is available to authorized users.

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The EATV index is associated with the prevalence of PAF and PeAF, and its cutoff values are predictive for PAF and PeAF development independently of other AF risk factors.